Clark Drug Company, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

09552/1.1 Issued in MS

Legal business name

CLARK DRUG COMPANY, LLC

Doing business as

Caledonia Pharmacy

Practice address

741 Main St
Caledonia, MS 39740-7609

Phone

(662) 356-4000

Fax

(662) 356-4044

NPI assigned

Nov 14, 2011

Last updated

May 19, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert Justin Clark, PHARMDNPI 1356944003

Title

Owner/ Pharmacist in Charge

Phone

(662) 356-4000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Caledonia Pharmacy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert Justin Clark, PHARMD

  • Pharmacist
  • Caledonia, MS
  • NPI 1356944003
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684454400000",
    "number": "1013294461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 478",
            "city": "CALEDONIA",
            "state": "MS",
            "postal_code": "397400478",
            "telephone_number": "662-356-4000",
            "fax_number": "662-356-4044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 MAIN ST",
            "city": "CALEDONIA",
            "state": "MS",
            "postal_code": "397407609",
            "telephone_number": "662-356-4000",
            "fax_number": "662-356-4044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK DRUG COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-14",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER/ PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "662-356-4000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "09552/1.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03406798",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Caledonia Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Caledonia Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alvin Ray Beezley Jr., D. O.
• Blissful Moments Doula & Birth Services, LLC.
• Caledonia Community Clinic, LLC
• Lee Vester Calvert Jr., FNP-C
• Robert Justin Clark, PHARMD
• Kathryn Comer
• Kelsey Melane Dement
• Fig Leaf, LLC (Caledonia Community Clinic)
• Misty S Glasgow, OTR

• Community/Retail Pharmacy in Caledonia, MS
• Providers in Caledonia, MS by specialty
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.